Optical coherence tomography in papilledema: what am I missing?

Area of Science:

• Ophthalmology
• Medical Imaging
• Neurology

Background:

• Papilledema grading is subjective, with poor interobserver agreement using current scales like the Frisen scale.
• Ophthalmoscopy is challenging for non-experts, potentially delaying papilledema diagnosis and treatment, risking vision loss.
• Distinguishing papilledema from pseudopapilledema and assessing vision loss causes in swollen optic nerves are clinical challenges.

Purpose of the Study:

• To critically assess the role of Optical Coherence Tomography (OCT) in diagnosing papilledema.
• To evaluate OCT's utility in assessing papilledema severity on a continuous scale.
• To explore OCT's capability in identifying causes of vision loss associated with optic nerve swelling.

Main Methods:

• A literature review of studies published between 2000 and 2014 was conducted.
• The review focused on the use of OCT for diagnosing papilledema, differentiating it from pseudopapilledema, and evaluating visual loss.
• Studies examining OCT's ability to provide a continuous severity scale for papilledema were included.

Main Results:

• OCT analysis of retinal layers can have segmentation artifacts, but newer 3D algorithms improve accuracy.
• Disc volume measured by OCT is a promising, robust, continuous measure of papilledema severity.
• OCT can identify buried optic disc drusen and subretinal fluid, aiding in differential diagnosis and assessment of reversible vision loss.

Conclusions:

• Disc volume, subretinal fluid, buried optic disc drusen, and retinal ganglion cell layer thickness are key OCT-derived features for papilledema assessment.
• OCT provides an advanced imaging approach for objective papilledema diagnosis and severity grading.
• OCT aids in early detection of neuronal injury and identification of reversible causes of vision loss in papilledema.